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POLIOMYELITIS AND SCHOOL INFECTION.
964
Annotations. "
Ne
quid nimis."
DR. FOORD CAIGER’S RETIREMENT FROM THE M.A.B. Dr. Frederick Foord Caiger retired from the service of the Metropolitan Asylums Board on Oct. 4th after an association of 39 years with the work of the infectious hospitals. He entered the service of the Board in 1887 as an assistant medical officer. and two years later was appointed medical superintendent of the South-Western Hospital, a post he continued to hold until his retirement. In 1893 his services were utilised in the opening of the Fountain Fever Hospital, Tooting, and six years afterwards he was deputed to open and organise the administration of the Grove Fever Hospital, Tooting, an institution of over 500 beds, which was urgently needed to meet an unusually high seasonal rise of enteric fever. At the end of 1921 Dr. Caiger was appointed chief medical officer of the Board’s Infectious Hospitals Service, becoming at the same time emeritus physician to St. Thomas’s Hospital. In his responsible position of fever chief he was called upon to guide the policy of the Board in such important questions as the use of the Schick test, the early administration of antitoxin in diphtheria, and the provision in the hospitals for cases of measles. Dr. Caiger was the first chairman of the Scientific Advisory Committee set up by the Board, after consultation with the Medical Research Council, to advise on the extension of knowledge by research and the full and prompt application of available knowledge to fever practice. As an outcome of this advice the Board in 1925 appointed a director of research and pathological services and decided to establish two thoroughly equipped group laboratories. Dr. Caiger’s retirement will mean the loss to the Metropolitan Asylums Board of a wise and tactful administrator, and to the medical staff and students of a good clinician and an attractive teacher. In many capacities he has contributed to the efficiency of the public health services of the metropolis. We are glad to learn that his help will remain available to private practitioners in the difficulties which arise in the diagnosis and treatment of fevers.
POLIOMYELITIS AND SCHOOL INFECTION. WE referred last week to the fact that the autumn increase in the prevalence of acute poliomyelitis and acute polio-encephalitis was greater this year than usual. Poliomyelitis was separated from other forms of paralysis and defined as a clinical entity by Heine in 1840 ; in 1887 Medin called attention to its occurrence in epidemic form ; in 1913 Flexner and Noguchi isolated an organism which was capable of producing the disease in monkeys and could be recovered from the diseased animals in pure culture. This organism was present in the pharyngeal secretion of a large proportion of sufferers from the disease, and also in the secretions of contacts and of certain patients who presented non-nervous symptoms. The disease is now regarded as a specific infection, and, though many questions in regard to its epidemiology still remain unsolved, it is established that only a fraction of those who are infected develop the paralytic form of the disease. It would appear that the great majority of the population in civilised communities is immune to the infection, or at any rate well protected against it. Children in the first year of life seem almost immune ; those in the second, third, and fourth years are the chief sufferers and account for 80 per cent. of all cases ; after the age of 4 the incidence declines rapidly. The fact that school infection rarely plays any noticeable part in the spread of the disease in the larger communities suggests that nearly all children in such areas are immune by the time school age is reached. It seems likely that the
immunity they possess is not the result of any bodily change as they get older, but is acquired by mild infection, for in rural districts with their more limited intercourse, the disease is acquired later than in towns, the average age of incidence being somewhat higher. In a community from which poliomyelitis
has been completely absent for a number of years, the younger children may have had no chance of acquiring immunity and school infection may become a danger. Wickmann, in his study of the Swedish epidemic, recorded several instances of it. The accountof the smaller but more recent Tubingen epidemic of 1922contains two instances of the spread of infection through institutions in which the children had had no chance of acquiring immunity. In a village several miles from Tubingen an epidemic " of influenza " with catarrh of the upper air passages as its chief symptom fell upon the infants’ school and affected so many children that the school was closed by the authorities. Then the true nature of the infection was revealed, for the teacher and one of the pupils died from paralysis. The second instance was in a home for infants comprising 14 children ; all the inmates suffered from "feverish colds" and their all very similar, suggested an temperature charts, " " ordinary slight influenza epidemic. But paralysis appeared in three of them. In another German village where poliomyelitis had not been encountered for 11years still another instance was observed2; a boy, who himself later suffered from paralysis, is believed to have contracted the infection from a case in the street in which he lived, and continuing to attend school while suffering from catarrhal and even paralytic symptoms he was apparently the means of bringing the infection into his school, and the disease in its paralytic form into the homes of three of his class-mates, four members of these families being involved. Oppenheim supports the statement that an increase in the prevalence of poliomyelitis during the school term and a decrease during the holidays has repeatedly been observed. If a country succeeded by hygienic measures in stamping out the infection for, say, ten years, it would appear to be rendering itself liable to the danger of an epidemic in its schools. Should this be accepted, prophylaxis would lie not so much in hygiene as in the development of a positive means of producing immunity-a method similar to those now being employed for diphtheria and scarlatina, or, as a more temporary measure, the administration of immune serum obtained from convalescents, and, if a suitable technique can be devised, from animals.
STANDARDISATION OF ARSPHENAMINES. IN the September number of Clinical Medicine will be found an article on the standardisation of arsphenamine, bv G. W. Raiziss, who points out that since the introduction of arsphenamine and its derivatives mercury occupies a position of secondary importance in the treatment of syphilis. These products have remarkable effects upon syphilitic symptoms and the Wassermann reaction, and their therapeutic efficiency in experimental trypanosomiasis is very marked, the injection of a dose very much below the maximum tolerated dose producing a complete disappearance of trypanosomes from the blood of rats, even where millions of the parasites had previously been present. Discussing the chemical constitution of the arsphenamine group and the reactions resulting from the administration of these compounds, Dr. Raiziss ascribes the cause of these reactions to impurities in the drug, and points out the necessity for a standard which will reduce the toxicity and retain the curative power of the substance. The United States Government assessment of the tolerated dose of arsphenamine in experimental animals is 120 mg. per kg. of body-weight, and for neoarsphenamine 240 mg. per kg. of body1
Schall: Münch. med. Wochenschr., 1923, lxx., 763. 2 Graef : Ibid., 1925, lxxii., 55.
Annotations. "
Ne
quid nimis."
DR. FOORD CAIGER’S RETIREMENT FROM THE M.A.B. Dr. Frederick Foord Caiger retired from the service of the Metropolitan Asylums Board on Oct. 4th after an association of 39 years with the work of the infectious hospitals. He entered the service of the Board in 1887 as an assistant medical officer. and two years later was appointed medical superintendent of the South-Western Hospital, a post he continued to hold until his retirement. In 1893 his services were utilised in the opening of the Fountain Fever Hospital, Tooting, and six years afterwards he was deputed to open and organise the administration of the Grove Fever Hospital, Tooting, an institution of over 500 beds, which was urgently needed to meet an unusually high seasonal rise of enteric fever. At the end of 1921 Dr. Caiger was appointed chief medical officer of the Board’s Infectious Hospitals Service, becoming at the same time emeritus physician to St. Thomas’s Hospital. In his responsible position of fever chief he was called upon to guide the policy of the Board in such important questions as the use of the Schick test, the early administration of antitoxin in diphtheria, and the provision in the hospitals for cases of measles. Dr. Caiger was the first chairman of the Scientific Advisory Committee set up by the Board, after consultation with the Medical Research Council, to advise on the extension of knowledge by research and the full and prompt application of available knowledge to fever practice. As an outcome of this advice the Board in 1925 appointed a director of research and pathological services and decided to establish two thoroughly equipped group laboratories. Dr. Caiger’s retirement will mean the loss to the Metropolitan Asylums Board of a wise and tactful administrator, and to the medical staff and students of a good clinician and an attractive teacher. In many capacities he has contributed to the efficiency of the public health services of the metropolis. We are glad to learn that his help will remain available to private practitioners in the difficulties which arise in the diagnosis and treatment of fevers.
POLIOMYELITIS AND SCHOOL INFECTION. WE referred last week to the fact that the autumn increase in the prevalence of acute poliomyelitis and acute polio-encephalitis was greater this year than usual. Poliomyelitis was separated from other forms of paralysis and defined as a clinical entity by Heine in 1840 ; in 1887 Medin called attention to its occurrence in epidemic form ; in 1913 Flexner and Noguchi isolated an organism which was capable of producing the disease in monkeys and could be recovered from the diseased animals in pure culture. This organism was present in the pharyngeal secretion of a large proportion of sufferers from the disease, and also in the secretions of contacts and of certain patients who presented non-nervous symptoms. The disease is now regarded as a specific infection, and, though many questions in regard to its epidemiology still remain unsolved, it is established that only a fraction of those who are infected develop the paralytic form of the disease. It would appear that the great majority of the population in civilised communities is immune to the infection, or at any rate well protected against it. Children in the first year of life seem almost immune ; those in the second, third, and fourth years are the chief sufferers and account for 80 per cent. of all cases ; after the age of 4 the incidence declines rapidly. The fact that school infection rarely plays any noticeable part in the spread of the disease in the larger communities suggests that nearly all children in such areas are immune by the time school age is reached. It seems likely that the
immunity they possess is not the result of any bodily change as they get older, but is acquired by mild infection, for in rural districts with their more limited intercourse, the disease is acquired later than in towns, the average age of incidence being somewhat higher. In a community from which poliomyelitis
has been completely absent for a number of years, the younger children may have had no chance of acquiring immunity and school infection may become a danger. Wickmann, in his study of the Swedish epidemic, recorded several instances of it. The accountof the smaller but more recent Tubingen epidemic of 1922contains two instances of the spread of infection through institutions in which the children had had no chance of acquiring immunity. In a village several miles from Tubingen an epidemic " of influenza " with catarrh of the upper air passages as its chief symptom fell upon the infants’ school and affected so many children that the school was closed by the authorities. Then the true nature of the infection was revealed, for the teacher and one of the pupils died from paralysis. The second instance was in a home for infants comprising 14 children ; all the inmates suffered from "feverish colds" and their all very similar, suggested an temperature charts, " " ordinary slight influenza epidemic. But paralysis appeared in three of them. In another German village where poliomyelitis had not been encountered for 11years still another instance was observed2; a boy, who himself later suffered from paralysis, is believed to have contracted the infection from a case in the street in which he lived, and continuing to attend school while suffering from catarrhal and even paralytic symptoms he was apparently the means of bringing the infection into his school, and the disease in its paralytic form into the homes of three of his class-mates, four members of these families being involved. Oppenheim supports the statement that an increase in the prevalence of poliomyelitis during the school term and a decrease during the holidays has repeatedly been observed. If a country succeeded by hygienic measures in stamping out the infection for, say, ten years, it would appear to be rendering itself liable to the danger of an epidemic in its schools. Should this be accepted, prophylaxis would lie not so much in hygiene as in the development of a positive means of producing immunity-a method similar to those now being employed for diphtheria and scarlatina, or, as a more temporary measure, the administration of immune serum obtained from convalescents, and, if a suitable technique can be devised, from animals.
STANDARDISATION OF ARSPHENAMINES. IN the September number of Clinical Medicine will be found an article on the standardisation of arsphenamine, bv G. W. Raiziss, who points out that since the introduction of arsphenamine and its derivatives mercury occupies a position of secondary importance in the treatment of syphilis. These products have remarkable effects upon syphilitic symptoms and the Wassermann reaction, and their therapeutic efficiency in experimental trypanosomiasis is very marked, the injection of a dose very much below the maximum tolerated dose producing a complete disappearance of trypanosomes from the blood of rats, even where millions of the parasites had previously been present. Discussing the chemical constitution of the arsphenamine group and the reactions resulting from the administration of these compounds, Dr. Raiziss ascribes the cause of these reactions to impurities in the drug, and points out the necessity for a standard which will reduce the toxicity and retain the curative power of the substance. The United States Government assessment of the tolerated dose of arsphenamine in experimental animals is 120 mg. per kg. of body-weight, and for neoarsphenamine 240 mg. per kg. of body1
Schall: Münch. med. Wochenschr., 1923, lxx., 763. 2 Graef : Ibid., 1925, lxxii., 55.